This form is a durable power of attorney for health care. This document gives your agent authority to consent, to refuse to consent, or to withdraw consent to any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition. This power is subject to any statement of your desires and any limitations that you include in this document. The principal must list his/her desires, special provisions, and limitations. This form may be also used to specify the agent's authority to authorize an autopsy, anatomical donation, or disposition of remains. The principal may also use this form if he/she wants to limit the term of the durable power of attorney.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.